ATLANTA — Georgia Medicaid recipients are likely to find outdated directories for doctors, therapists and other medical providers as the state finds thousands of them have failed to revalidate their eligibility to receive payment for services.
Nearly 8,000 faced suspension starting this month, according to a state report in June that noted more than 60,000 others could follow in coming months.
The revalidation deadlines come as some providers are threatening to voluntarily exit the networks of CareSource and Peach State Health Plan, two of Georgia’s three Medicaid managed care organizations for pediatric services.
The organizations have contracts with the state that give them a fixed amount of money for each Medicaid recipient who enrolls with them. In turn, they must ensure their enrollees receive the medical care required under federal law.
Critics say CareSource and Peach State may be unable to follow through on their end of the bargain
The companies shocked pediatric therapy providers last spring by alerting them of 20% rate cuts. They said they would be cutting reimbursements to 80% of the Medicaid fee schedule. Therapists who reject CareSource’s rate cut were told they would be ejected from the organization’s network. That could eliminate access to care for many Georgia families, especially in rural areas that already have a dearth of providers.
The cost-cutting moves led to a hearing last week by a committee of the Georgia House of Representatives.
The Department of Community Health oversees the managed care organizations’ contracts. Lynnette Rhodes, the agency’s chief health policy officer, did not say at that hearing how many providers had quit CareSource’s network as a result of the rate cuts, but she said the agency was getting reports from the organization about it. She also said the revalidation process would eventually clarify how many remain.
“It will give real clarity in terms of which providers are actually operating and where,” she said. “It’s been quite some time since we have completed that process in Georgia.”
Jesse Weathington, an industry lobbyist, fielded some questions from angry lawmakers. He said the rate cuts were probably a reaction to rapidly rising demand for pediatric therapy, which he said increased by 62% from 2018 to 2025, with demand for autism care rising more like 300%.
Weathington speculated that the growth was driven by increasing awareness and diagnosis.
He said the organizations can renegotiate payment terms with the state each year.
“But we still have a commitment,” he said. “We have to make sure that a member gets seen.” Republicans and Democrats on the panel were not happy with the situation. They started getting calls about the rate cuts from constituents soon after their regular legislative session ended in early April.
“The excuse is ‘well, we didn’t anticipate this growth,'” said Rep. Jesse Petrea, R-Savannah, a member of the House Health Committee. “Well, that’s your job to anticipate the demand and the need for services.”
The committee met on June 23, after lawmakers returned to the Capitol for a special session.
Rhodes told the committee that state Medicaid contractors had authority to unilaterally cut payment rates and terminate providers and that providers knew that when they signed up to be in their networks. She said it was standard practice across the country.
She said it was the duty of managed care organizations to pay for necessary care, even if it meant sending patients out of their networks or paying higher rates on a case-by-case basis.
Providers who spoke at the hearing predicted that the cuts would trigger clinic closures while undermining savings from the rate cuts by triggering higher out-of-network bills.
“Pediatric therapy providers have struggled for a long time. They’re at a breaking point due to this recent notification of rate reductions,” said Margaret Ann Parker, founder of Speech Therapy Services in Southwest Georgia. “If these cuts move forward, clinics will close and we are already seeing this happen.”
Parker said her clinic serves patients from five nearby counties that already lack therapy providers, calling those communities a “therapy desert.”
Federal law requires care organizations to prove their ability to provide all required services when they make deep rate cuts. It then falls on the state to assure compliance.
Roland Behm, a health policy advocate, wrote a memo to lawmakers on the panel that said Georgia had given CareSource about $2.3 billion in Medicaid money in fiscal year 2025. In the memo, which he shared with Capitol Beat News Service, Behm questioned whether the state was getting its money’s worth from contractors for Medicaid and PeachCare for Kids, the state health care program for uninsured children.
“The issue is not the rate cut alone,” he wrote. “The issue is whether Georgia is still buying real access to medically necessary care for its Medicaid and PeachCare enrollees, approximately 70% of whom are under the age of 21.”
Neal Jacobovits, who serves on the board of the Autism Families Alliance, said in a statement to Capitol Beat this week that the rate cuts will cause some families to experience delayed care or even lose access altogether. He said an increase in diagnoses should not reduce access for the families Medicaid is supposed to serve.
“Parents grappling with a new autism diagnosis will be forced to navigate even longer waitlists for care,” he said, “and those in rural communities where services are already limited may be left wondering if they can access any care at all.”